{"id":1212,"date":"2024-04-02T09:09:00","date_gmt":"2024-04-01T23:39:00","guid":{"rendered":"https:\/\/hepatitissa.asn.au\/magazine-dev\/?p=1212"},"modified":"2024-04-10T23:53:12","modified_gmt":"2024-04-10T14:23:12","slug":"global-elimination-low-middle-countries-need-new-financing-strategies","status":"publish","type":"post","link":"https:\/\/hepatitissa.asn.au\/communitynews\/2024\/04\/global-elimination-low-middle-countries-need-new-financing-strategies\/","title":{"rendered":"Global Elimination: Low-Middle Income Countries Need New Financing Strategies"},"content":{"rendered":"\n<p class=\"has-drop-cap\">Global elimination of hepatitis C can only be achieved if innovative ways can be found for low- and middle- income countries to finance treatment so that it is affordable for the vast majority of people around the world living with the virus. This was the conclusion in a new study from the <a href=\"https:\/\/www.kirby.unsw.edu.au\/\" target=\"_blank\" rel=\"noreferrer noopener\">Kirby Institute<\/a>.<\/p>\n\n\n\n<p>Direct-acting antivirals (DAAs) have been a massively effective weapon in the fight to eliminate hepatitis C, with a cure rate of more than 95 per cent but access to these live-saving treatment is very dependent on where you live, the researchers found. <\/p>\n\n\n\n<p>Almost 90 per cent of the 57 million people living with hepatitis C across the world are in low- and middle-income countries, and only half of these countries currently provide DAA treatments at an accessible cost, says the study, <a href=\"https:\/\/www.thelancet.com\/journals\/langas\/article\/PIIS2468-1253(23)00335-7\/abstract\" data-type=\"link\" data-id=\"https:\/\/www.thelancet.com\/journals\/langas\/article\/PIIS2468-1253(23)00335-7\/abstract\" target=\"_blank\" rel=\"noreferrer noopener\">published in <em>The Lancet<\/em> <em>Gastroenterology &amp; Hepatology<\/em> journal<\/a>.<\/p>\n\n\n\n<p>The research examined the registration, reimbursement and restrictions for hepatitis C treatments across 160 countries, representing approximately 95 per cent of the global population. There are between 190 and 200 countries in the world, depending on whose definition you use.<\/p>\n\n\n\n<p>\u201cCurrent direct-acting antiviral treatments [are] revolutionising the way we manage this condition. But there remains a high cost to the treatment in most countries, which has led to a disparate rollout globally, with many countries placing restrictions both on who can access it and who can prescribe it,\u201d explained Dr Alison Marshall, who led the research at the Kirby Institute.<\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d73bae3a5d5&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d73bae3a5d5\" class=\"wp-block-image aligncenter size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"1200\" height=\"799\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image.jpeg\" alt=\"Alcohol use restrictions on reimbursement of direct-acting antiviral drugs for patients with HCV infection and recent alcohol dependence by country\" class=\"wp-image-1739\" srcset=\"https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image.jpeg 1200w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-600x400.jpeg 600w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-300x200.jpeg 300w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-768x511.jpeg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Alcohol use restrictions on reimbursement of direct-acting antiviral drugs for patients with HCV infection and recent alcohol dependence by country<\/figcaption><\/figure>\n\n\n\n<p>\u201cUniversal access to health coverage means all people should have access to the full range of quality services they need, irrespective of who they are, where they are born, or the nature of their health condition.\u201d<\/p>\n\n\n\n<p>According to the research, of the 160 countries analysed, 91 per cent have at least one hepatitis C treatment registered, but only two thirds of countries provide their residents with access to reimbursed (subsidised) treatment, in the way that Australians can access DAAs through the <a href=\"https:\/\/www.pbs.gov.au\/pbs\/home\" target=\"_blank\" rel=\"noreferrer noopener\">Pharmaceutical Benefits Scheme (PBS)<\/a> at minimal cost. Among low- and middle-income countries, just over half provide reimbursement. Seven countries restrict access based on drug use and five based on alcohol use, something for which there is no good reason in terms of treatment efficacy.<\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d73bae3b587&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d73bae3b587\" class=\"wp-block-image aligncenter size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"1200\" height=\"795\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-1.jpeg\" alt=\"Illicit drug use restrictions on reimbursement of direct-acting antiviral drugs for patients with HCV infection and recent drug dependence by country\" class=\"wp-image-1740\" srcset=\"https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-1.jpeg 1200w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-1-600x398.jpeg 600w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-1-300x199.jpeg 300w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-1-768x509.jpeg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Illicit drug use restrictions on reimbursement of direct-acting antiviral drugs for patients with HCV infection and recent drug dependence by country<\/figcaption><\/figure>\n\n\n\n<p>\u201cGiven that the majority of people living with hepatitis C live in low- and middle-income countries, we need to see much higher numbers of countries providing reimbursement for hepatitis C therapies, especially if we are to meet the World Health Organization target to eliminate hepatitis C as a public health threat by 2030,\u201d Dr Marshall said. \u201cMost people living with hepatitis C globally are marginalised and face multiple challenges to accessing care. If cost is a barrier to seeking cure, they are unlikely to seek treatment, which poses risks for their health, as well as for onward transmission.\u201d<\/p>\n\n\n\n<p>Another barrier to accessing DAAs is who can prescribe the medications. The analysis found that in 61 per cent of countries, a specialist (e.g., a liver disease specialist or infectious disease specialist) was required to prescribe the medication. This restriction reduces the proportion of available prescribers and most often requires patients to receive treatment from a specialist centre, often hospital-based.<\/p>\n\n\n\n<figure class=\"wp-block-pullquote\"><blockquote><p>&#8230;need for more innovative financing models to encourage and facilitate increased access to treatment&#8230;<\/p><\/blockquote><\/figure>\n\n\n\n<p>\u201cThis is a major barrier for marginalised population groups such as people who use or inject drugs \u2013 people who are more likely to experience stigma in healthcare settings and avoid attending hospital-based centres. Increasing task sharing of hepatitis C testing and treatment to non-specialised centres such as primary care centres would broaden access,\u201d explained Professor Jason Grebely, head of the Hepatitis C and Drug Use Group in the Viral Hepatitis Clinical Research Program at the Kirby Institute, and senior author on the paper.<\/p>\n\n\n\n<p>The researchers conclude that there is a need for more innovative financing models to encourage and facilitate increased access to treatment, especially in low- and middle-income countries.<\/p>\n\n\n\n<p>\u201cThere have been some great initiatives, such as the Clinton Health Access Initiative, and The Hepatitis Fund who have helped to facilitate price agreements with generic manufacturers to provide treatments to low- and middle-income countries for $US60 per treatment course, but we need to do more to assist countries to increase access to these lifesaving treatments,\u201d said Professor Grebely.<\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d73bae3c320&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d73bae3c320\" class=\"wp-block-image size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"1200\" height=\"801\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-2.jpeg\" alt=\"Prescriber-type restrictions on reimbursement of direct-acting antiviral drugs for patients with HCV infection by country\" class=\"wp-image-1741\" srcset=\"https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-2.jpeg 1200w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-2-600x401.jpeg 600w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-2-300x200.jpeg 300w, https:\/\/hepatitissa.asn.au\/communitynews\/wp-content\/uploads\/2024\/03\/image-2-768x513.jpeg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Prescriber-type restrictions on reimbursement of direct-acting antiviral drugs for patients with HCV infection by country<\/figcaption><\/figure>\n\n\n\n<p>This is vitally important. Consider Egypt, a country that until 10 years ago had one of the world&#8217;s highest rate of hepatitis C, and where the average weekly wage is equivalent to less than AU$50. Most people under this financial pressure simply do not have the money to spare to pay for medical treatment unless it is massively subsidised or even free. So the Egyptian government provided free HCV testing and treatment for the population, and now Egypt has one of the world&#8217;s lowest HCV rates, and is the <a data-type=\"link\" data-id=\"https:\/\/www.emro.who.int\/media\/news\/egypt-becomes-the-first-country-to-achieve-who-validation-on-the-path-to-elimination-of-hepatitis-c.html#:~:text=Egypt%20has%20successfully%20transitioned%20from,in%20just%20over%20a%20decade.\" href=\"https:\/\/www.emro.who.int\/media\/news\/egypt-becomes-the-first-country-to-achieve-who-validation-on-the-path-to-elimination-of-hepatitis-c.html#:~:text=Egypt%20has%20successfully%20transitioned%20from,in%20just%20over%20a%20decade.\" target=\"_blank\" rel=\"noreferrer noopener\">first to achieve WHO validation on the path to elimination of hepatitis C<\/a>.<\/p>\n\n\n\n<p>Chief Executive Officer of the <a href=\"https:\/\/www.worldhepatitisalliance.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">World Hepatitis Alliance<\/a>, Rachel Halford, says the research is both alarming and timely.<\/p>\n\n\n\n<p>\u201cWe hope this research will motivate action from policymakers and healthcare professionals globally, as the urgency to tackle hepatitis cannot be overemphasised.<\/p>\n\n\n\n<p>\u201cEliminating viral hepatitis will prevent hundreds of thousands of lives lost to liver cancer and other liver diseases resulting from chronic hepatitis. As a global hepatitis community, we must collaborate to drive change. We commend the Kirby Institute\u2019s contribution to this global collaboration with this research.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Direct-acting antivirals is the most effective weapon in the fight to eliminate hepatitis C, but access is very dependent on which country you&#8217;re in.<\/p>\n","protected":false},"author":3,"featured_media":1216,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_FSMCFIC_featured_image_caption":"","_FSMCFIC_featured_image_nocaption":"","_FSMCFIC_featured_image_hide":"","footnotes":""},"categories":[11],"tags":[32,36,39],"issue":[],"ppma_author":[57],"class_list":["post-1212","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-policies-research","tag-hepatitis-c","tag-hepatitis-elimination","tag-treatment"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - 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